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Mark Farrah Associates: The Current State of the Individual Health Insurance Market

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- Mark Farrah Associates (MFA), www.markfarrah.com, released an analysis brief providing insights into the current state of the individual health market segment. According to the Centers for Medicare & Medicaid Services (CMS) reports combined with data from MFA's Health Coverage Portal™, 69.5% of 17.6 million individual medical members were enrolled through the Marketplace as of March 2017. The remaining 30.5% of this segment, or 5.36 million covered lives, were enrolled in off-exchange plans (see also Mark Farrah Associates).

In "A Brief Look at the Turbulent Individual Health Insurance Market" Mark Farrah Associates reported enrollment in individual, non-group medical plans totaled 17.6 million as of March 2017, according to financial statements filed by insurers, with the largest states commanding the highest membership totals. Although Marketplace reports indicate 3.82 million new members enrolled in 2017, year-over-year individual market enrollment actually declined by about 12%. Total individual market enrollment, based on carrier reports, was 20.2 million a year ago in March 2016. Anthem, Centene, Kaiser, Guidewell Mutual Holding Group (the parent company of Blue Cross Blue Shield affiliates operating in Florida), Health Care Service Corporation (HCSC), and Molina Healthcare lead the industry in this segment, each reporting more than a million individual medical covered lives as of 1st quarter 2017.

Insurers collectively lost almost $4.7 billion in the segment last year and out of 179 companies that filed the 2016 Supplemental Health Care Exhibit (SHCE), 70%, or 126 companies, reported aggregate net losses in the individual, non-group segment. MFA cited key contributing factors resulting in significant losses on Marketplace business such as high medical claims, adverse selection, 3Rs program challenges, immature risk pools, and under-enrollment of younger, healthier individuals. While several health insurers are working to firm up rates for 2018 individual plans and gear up for open enrollment beginning November 1, 2017, many other carriers have withdrawn from the Marketplace altogether. As the country awaits governing decisions about the future of our health care system, Mark Farrah Associates will continue to report on the ever changing and unpredictable industry.